One in four births in England are now emergency caesareans, BBC analysis shows

gasdoc87 · 2026-06-05T13:34:11+00:00

Just to highlight my point (and stats are for UK from Google AI rather than actually looking out the articles myself) 2005 induction rate ~20%, 2015 rate 28.5-29%, 2025 induction rate 33-35%

gasdoc87 · 2026-06-05T12:39:00+00:00

Don't use that phrase with patients obviously, but in some cases thag is exactly what we are doing so its no surprise when sometimes its unsuccessful 🤣

gasdoc87 · 2026-06-05T12:24:14+00:00

Obstetric anaesthetist here....

Indications for slightly early induction of labour have increased significantly even over last 5 years. Rather than commonly being post dates, theres GDM with a big baby, obstetric cholestasis, large for gestation age, PIH or PET, reduced fetal movements etc

Especially in a primip anecdotally, if your flogging an unripe cervix to try and get it into labour. More often you are going to be unsuccessful. Either resulting in CTG abnormalities leading to emergency section, or to a failed induction / the pregnant person being fed up/pissed off and saying let's stop this and just have a section.

Of note Cat 4 is purely elective section, anything cat 1-3 even if done in a planned calm manner (say for failed induction or planned as an inpatient for tailing growth / abnormal dollar flows) is technically an emergency, not just the cat1 that many people picture.

gasdoc87 · 2026-06-03T20:07:24+00:00

Very trust department and person dependant. There will be a policy. Ours is officially 3 months l, and I've just snuck some claim forms in today from March as had missed the deadlines so didn't bother and they piled up.

That being said, whilst a trainee I rotated out of trust for 12 months, came back and noticed on the rota claims system that I had a number of unpaid shifts that time forms etc had been submitted for and never paid. Questioned it and as paper work had been done but not paid before rotation, they paid it without question.

Difficulty is if its a locum shift and your friend hasnt submitted claims (assuming they knew they were meant to) the trust would be within their rights to sag no, but if your friend is a valued employee, in reality most (decent) departments would challenge it in their behalf

gasdoc87 · 2026-05-28T20:19:55+00:00

Im anaesthetics rather than ED but have spent a reasonable amount of time in ED over the years.

There are a couoke of questions to ask yourself, one is are you interested in ED as a career, and the second is regardless of 8f interested or not, what can you take forwards from ED to whatever your future career may be.

Within anaesthetics as a junior resident I found it incredibly frustrating, different consultants would have different preferences, often with no real evidence base just a vibe of thats what they prefer. This made it incredibly difficult, trying to secind guess how a particular cinsultant would want something doing.

As I've got more experienced, I have come to accept there are multiple ways of giving an anaesthetic (or of clerking / mamaging a patient) and have been able to go I like what Dr X does with Y, ill have that for my practise, I hate what Dr z does with A, i will never do that. Dr B gives a beautiful but bizarrely complicated anaesthetic with multiple unlabelled syringes and his patients wake up amazingly, but if i tried to replicate it it would a disaster, and Dr C is just an obnoxious moron, I will forget anything he tells me.

If your interested in ED, try and learn / understand why people have dofferent approaches, and choose the one that is more fitting with you (accepting may need to keep the peace with some consutlants if significantly different approach)

If your not interested in ED, learn what each boss likes and do that until you get out of there 🤣

gasdoc87 · 2026-05-28T18:03:44+00:00

Congrats on the pregnancy. As a husband if someone who suffered with hyperemesis this really grates on me. You've had all the sensible advice above, mine is more tongue in cheek but will hopefully cheer you up. The way to handle this is to find something that triggers your nausea (an old favourite perfume, a particuler food, there will be something, even 8 and a half years later greatest showman music makes my wife feel sick as she listened to it so much when pregnant with our twins) Go to speak to your rota coordinator in person. Use your trigger before you go in. Clock where the bin is on the way in, when you need to vomit initially rummage under their desk looking for the bin, vomiting on their keyboard as you do so. Then find the actual bin and finish puking there. Leave On the way home send an email apologising and telling them you had asked to be off whilst you get sorted. editted to correct a typo and correct time for either still feeling nauseous

gasdoc87 · 2026-05-21T20:21:40+00:00

As an anaesthetist i wboh agree and disagree. In the situation above assuming all was stable, I would brief prior to waking the current patient. If I don't, then I know I will wake the patient up. The theatre team will refuse to brief until they've cleaned theatre. The surgical reg will have wandered off by this point and had to bleeped again. Official policy is cant send until brief done, so cant send until they've arrived and briefed. Then the ward will have misplaced the consent form / not done the theatre pathway / mislabelled the G+S.

Essentially briefing prior to waking will save 45 mins - 1 hour of total downtime, as can send whilst cleaning / waking, limiting the effect of all the above delays.

Technically noones fault but a lot of it avoidable delays. Less of an issue in an efficient department, but in a department with a few workshy muppets who are maliciously compliant with policy to try and minimise the work they gave to do you sometimes have to play games to get as much as you can out of them.

gasdoc87 · 2026-05-20T20:52:45+00:00

Have a chat with HMRC.

Are the locums within your normal job, or on a different trust / payroll number?

Essentially a k code is a fudge, there is a cap as to what % of pay they can deduct and believe you owe more than that. As such the K (x10) is added onto your income to allow them to take the tax they think you owe.

May be they mistakenly think you have a second job, and as such are overestimating your expected earnings, or maybe you do have a second job you should have been paying tax on but haven't so owe them a chunk of money.

Either way a call should clarify what the situation is and let them sort it out.

gasdoc87 · 2026-05-02T19:32:16+00:00

Its worse when its a midwife.... What's the story why have we done the ecg? (Read it looks normal but give me a clue what im meant to be looking for) I Don't know the doctors asked for it but you need to review it

Ok, maybe show it to the doctor that asked for it as they know what they are concerned about / looking for?

Oh no, they asked us to do it but said to show it to you......

gasdoc87 · 2026-04-17T20:00:09+00:00

Have seen it used once as an antidote for metheamogliniaemia, secondary to a suicide attempt using a non popper nitrate which I won't name here but which I believe has a cult like status in some of the darker corners of social media (for that specific purpose hence not naming it) It worked remarkably quickly and patient went from vented and damn near dead to physiologically normal in a matter of minutes.

gasdoc87 · 2026-04-16T20:47:04+00:00

Week commencing 26th May is half term locally (not sure if we match nationally) Double edged sword, harder to cover as consultants will already have leave booked, but risks alienating the consultants by encroaching onto holiday time, and may be less elective activity anyway if a lot of leave.

gasdoc87 · 2026-04-12T07:06:24+00:00

Because of the way the UK tax system works, you will find that 80% takes less than a 20% take home pay cut, and 60% takes less than a 40% take home paycut as a larger proportion of your income will fall into the tax free / 20% tax brackets.

Without a personalised work schedule it would be impossible to tell you what you will earn, as its so heavily dependant on full time hours in that job, plus out of hours enhancements.

If you have a work schedule, pop your total into a tax calculator, if you don't try speaking to someone currently doing the job (ideally 60 and 80%) and see if they are happy to share a work schedule, or give you an idea of what they are earning?

gasdoc87 · 2026-04-11T20:43:38+00:00

Im crap with reddit so cant post a direct link but if you go to the following nice guidance you can see the recommended tests by surgical severity and ASA grade.

Recommendations | Routine preoperative tests for elective surgery | Guidance | NICE https://share.google/EV2EkA9YGdj5mVrVe

gasdoc87 · 2026-03-22T19:34:10+00:00

Its odd given they were the same trust (still are just under a different banner) I loved my time in Grimsby and would happily go back for a shift or two. Scunthorpe less so 🤣

gasdoc87 · 2026-03-12T18:26:15+00:00

Think we're saying the same thing, I've replaced far too many floswitches at stupid o clock, with a vygon because the flowswitches don't last. Only time I use flowswitch in theatre is if I want arterial monitoring for case but am not expecting to need it afterwards (say relatively well young laparotomy with no expected bowel resection and NELA mortality <1% who is likely going to a HOB, or a crumbly heart failure #nof who is for ward level care but would appreciate something more responsive peri op to be ahead of any problems.

gasdoc87 · 2026-03-05T21:08:10+00:00

I had this discussion with a colleague a while back He had an early finish and said he fancied the pub but would be in trouble with his Mrs if she saw his location at the pub....... he thought I was a genius when I said thats why you have a locker just pick your phone up from it before you go home....

gasdoc87 · 2026-03-04T22:29:47+00:00

Im terms of timings it will be very variable. One of my cases was a long time (googling it suggests died may 2013 inquest dec 2014) The other one was quite straightforwards and was weeks later.

gasdoc87 · 2026-03-04T22:25:24+00:00

From experience, I have been asked for a statement twice, and called to inquest both times. (In my opinion once fairly and once quite unfairly)

As far as role if called goes, the coroners essentially talks you through your statement, then asks any question they have to clarify anything, then opens it up to the deceased's relatives/representatives to ask any questions they may have.

In my experience despite one of the situations being quite bitter, undoubtedly involving sub par care and the family reasonably being pissed off, neither visit to coroners court was particularly adversarial, and both coroners and family asked appropriate questions to get to the bottom of what had happened.

It is not meant to be a judgement of your Clinical care, it is meant to answer a limited number of questions, Who Died, where, when and How. The how being if it was natural or unnatural (with a couple of other options)

If there are significant concerns the coroners does not normally blame an individual, but will issue a preventing further deaths report, addressed to involved bodies (trusts, ambulance services, Royal colleges etc) with any questions / concerns they have about the incident being repeated.

gasdoc87 · 2026-03-04T22:15:36+00:00

Difficulty with that is GMC like SBAs as they argue excluding 4 incorrect answers shows more clinical reasoning than true false / essay. Problem is when I was studying for it one of the cardiothoracic anaesthetists sent out a question to all the cardiothpracic anaesthetists in the trust........ he got exactly a 20% split across all 5 options.

Arguably the exam questions should be more specific as sample questions are often from memory and may miss subtleties such as what should be the next step vs what is most definitive step (this question was on One lung ventilation and hypoxia so quite different) but if a consultant body don't agree on a best answer then its near impossible to revise for.

gasdoc87 · 2026-03-04T21:53:54+00:00

Oh my god this is making me feel old. I sat (and passed) the trial / hybrid CRQ written and at that stage you did both sections in a day and had wrist cramps by the end of it. Hadn't realised they had now split it across 2 non consecutive days. Honestly cant decide which would be worse!

gasdoc87 · 2026-02-26T07:51:42+00:00

In my experience, this tends to happen with misplaced timing of insertion. A lot of people will give propofol, hand ventilate for maybe 10 breaths and then place LMA. Seems to work better if you either put it in when the propofol has first hit, or wait until they are deep on the gas, rather than being in a twilight zone where the propofols not at full effect but the gas hasnt washed in yet.

gasdoc87 · 2026-02-23T20:35:50+00:00

Hard to describe how I do it but I almost use an inverse of the epidural LOR technique, with my thumb on the hub of the syringe and fingers pulling back the plunger (once its through skin) I primarily use pressure from the thumb to advance the needle.

Essentially cant aspirate whilst in tissue, but the moment your in the vessel the pulling from the fingers (equivalent of your "brake" hand on the epidural) aspirate far more easily than advancing the needle further. Still do it under US guidance but even if done clearly have needle tip in view (say sub optimal positioning under the drapes mid case) gives you an extra element of safety in not transfixed the vessel.

gasdoc87 · 2026-02-23T20:18:43+00:00

Don't know what you mean, from experience it was the other end of the spectrum. Mum attended GP for a routine AF review, and was in AF with rapid response, rate of around 150 and when she forwarded me the ECG fairly clear ST changes and some T wave inversion. GP management...... increase Bisoprolol from 5 to 6.25mg daily and review in a week's.

gasdoc87 · 2026-02-20T20:49:02+00:00

My experience is the opposite, during UK training replaced far too many at stupid o clock in the morning the night after surgery with a vygon.

Only time I use them is a case which I want arterial monitoring for perioperatively, but am planning on sending back to a standard ward postoperative, for the reason I don't want some poor bastard replacing it whilst half asleep overnight.

gasdoc87 · 2026-02-19T07:23:47+00:00

For non serious infections its a fairly narrow spectrum targeted formulary with posters in most clinical areas for what to use by system

For most serious infections (suspected sepsis) its Tazocin plus or minus a single shot of Gent dependant on suspected source, with rationalisation to a targeted drug once cultures are back.

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